Zhen Xuemei, Stålsby Lundborg Cecilia, Sun Xueshan, Gu Shuyan, Dong Hengjin
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, (NHC Key Lab of Health Economics and Policy Research, Shandong University), Jinan 250012, China.
Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China.
Antibiotics (Basel). 2020 Aug 13;9(8):514. doi: 10.3390/antibiotics9080514.
Carbapenem resistant (CRKP), (CRPA), and (CRAB) pose significant threats to public health. However, the clinical and economic impacts of CRKP, CRPA, and CRAB remain largely uninvestigated in China. This study aimed to examine the clinical and economic burden of CRKP, CRPA, and CRAB compared with carbapenem susceptible cases in China. We conducted a retrospective and multicenter study among inpatients hospitalized at four tertiary hospitals between 2013 and 2015 who had , , and positive clinical samples. Propensity score matching (PSM) was used to balance the impact of potential confounding variables, including age, sex, insurance, number of diagnosis, comorbidities (disease diagnosis, and Charlson comorbidity index), admission to intensive care unit, and surgeries. The main indicators included economic costs, length of stay (LOS), and mortality rate. We included 12,022 inpatients infected or colonized with , , and between 2013 and 2015, including 831 with CRKP and 4328 with carbapenem susceptible (CSKP), 1244 with CRPA and 2674 with carbapenem susceptible (CSPA), 1665 with CRAB and 1280 with carbapenem susceptible (CSAB). After PSM, 822 pairs, 1155 pairs, and 682 pairs, respectively were generated. Compared with carbapenem-susceptible cases, those with CRKP, CRPA, and CRAB were associated with statistically significantly increased total hospital cost ($14,252, < 0.0001; $4605, < 0.0001; $7277, < 0.0001) and excess LOS (13.2 days, < 0.0001; 5.4 days, = 0.0003; 15.8 days, = 0.0004). In addition, there were statistically significantly differences in hospital mortality rate between CRKP and CSKP, and CRAB and CSAB group (2.94%, = 0.024; 4.03%, = 0.03); however, the difference between CRPA and CSPA group was marginal significant (2.03%, = 0.052). It highlights the clinical and economic impact of CRKP, CRPA, and CRAB to justify more resources for implementing antibiotic stewardship practices to improve clinical outcomes and to reduce economic costs.
耐碳青霉烯类肺炎克雷伯菌（CRKP）、耐碳青霉烯类铜绿假单胞菌（CRPA）和耐碳青霉烯类鲍曼不动杆菌（CRAB）对公众健康构成重大威胁。然而，CRKP、CRPA和CRAB在中国的临床和经济影响在很大程度上仍未得到研究。本研究旨在探讨在中国CRKP、CRPA和CRAB与碳青霉烯类敏感病例相比的临床和经济负担。我们对2013年至2015年期间在四家三级医院住院且临床样本检测出肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌阳性的患者进行了一项回顾性多中心研究。倾向评分匹配（PSM）用于平衡潜在混杂变量的影响，这些变量包括年龄、性别、保险类型、诊断数量、合并症（疾病诊断和查尔森合并症指数）、入住重症监护病房情况和手术情况。主要指标包括经济成本、住院时间（LOS）和死亡率。我们纳入了2013年至2015年期间感染或定植肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的12022名住院患者，其中831例为CRKP，4328例为碳青霉烯类敏感肺炎克雷伯菌（CSKP），1244例为CRPA，2674例为碳青霉烯类敏感铜绿假单胞菌（CSPA），1665例为CRAB，1280例为碳青霉烯类敏感鲍曼不动杆菌（CSAB）。经过PSM后，分别生成了822对、1155对和682对。与碳青霉烯类敏感病例相比，CRKP、CRPA和CRAB患者的总住院费用在统计学上显著增加（分别为14252美元，P<0.0001；4605美元，P<0.0001；7277美元，P<0.0001），住院时间延长（分别为延长13.天，P<0.0001；5.4天，P = 0.0003；15.8天，P = 0.0004）。此外，CRKP与CSKP组以及CRAB与CSAB组之间的医院死亡率在统计学上存在显著差异（分别为2.94%，P = 0.024；4.03%，P = 0.03）；然而，CRPA与CSPA组之间的差异接近显著（2.03%，P = 0.052）。这凸显了CRKP、CRPA和CRAB的临床和经济影响，证明需要投入更多资源来实施抗生素管理措施，以改善临床结局并降低经济成本。
